Abstract：
Effective workup and listing of end-stage renal disease (ESRD) patients for renal transplantation, often with multiple co-morbidities, poses a challenge for transplant teams. Obesity is a common co-morbidity associated with adverse outcomes in ESRD and kidney transplant (KT) recipients. Bariatric and metabolic surgery (BMS) has long been established as a safe and effective treatment for morbid obesity. In this study, the authors aimed to evaluate the strength of evidence for both the efficacy and safety of bariatric surgery in patients with ESRD or kidney transplantation.
A literature search was performed using key terms including \"transplantation\", \"kidney\", \"renal\", \"obesity\", and \"bariatric\". Databases searched include MEDLINE, EMBASE and Web of Science from inception to date (April 2021). Methodological quality was assessed using the Newcastle-Ottawa tool. Selected articles were then categorised into patients awaiting waiting list acceptance, patients awaiting transplantation, patients undergoing simultaneous BMS + KT and patients undergoing BMS following a previous renal transplant. Summary effects are presented with a level of statistical significance and 95% Confidence Intervals.
A total of 28 articles were selected following the literature search. Fourteen studies on patients awaiting listing (n = 1903), nine on patients on the KT waiting list (n = 196), a single study on simultaneous BMS and KT and ten studies on patients undergoing BMS following KT (n = 198). Mean change in BMI for patients awaiting listing was -11.3 kg/m2 (95%CI: -15.3 to -7.3, p < 0.001), mean change in BMI for patients listed for KT was -11.2 kg/m 2(95%CI: -12.9 to -9.5, p 0.001) and mean change for patients with prior KT was -11.0 kg/m2 (95%CI: -7.09 to -14.9, p < 0.001). The combined mortality rate for patients who had undergone both BMS and KT was 4% (n = 15).
This review demonstrates BMS is both safe and efficacious in patients with ESRD prior to KT and in those post KT. It would enable difficult-to-list obese recipients the possibility to undergo transplantation and should be considered as part of the work up process.
A literature search was performed using key terms including \"transplantation\", \"kidney\", \"renal\", \"obesity\", and \"bariatric\". Databases searched include MEDLINE, EMBASE and Web of Science from inception to date (April 2021). Methodological quality was assessed using the Newcastle-Ottawa tool. Selected articles were then categorised into patients awaiting waiting list acceptance, patients awaiting transplantation, patients undergoing simultaneous BMS + KT and patients undergoing BMS following a previous renal transplant. Summary effects are presented with a level of statistical significance and 95% Confidence Intervals.
A total of 28 articles were selected following the literature search. Fourteen studies on patients awaiting listing (n = 1903), nine on patients on the KT waiting list (n = 196), a single study on simultaneous BMS and KT and ten studies on patients undergoing BMS following KT (n = 198). Mean change in BMI for patients awaiting listing was -11.3 kg/m2 (95%CI: -15.3 to -7.3, p < 0.001), mean change in BMI for patients listed for KT was -11.2 kg/m 2(95%CI: -12.9 to -9.5, p 0.001) and mean change for patients with prior KT was -11.0 kg/m2 (95%CI: -7.09 to -14.9, p < 0.001). The combined mortality rate for patients who had undergone both BMS and KT was 4% (n = 15).
This review demonstrates BMS is both safe and efficacious in patients with ESRD prior to KT and in those post KT. It would enable difficult-to-list obese recipients the possibility to undergo transplantation and should be considered as part of the work up process.
摘要：
背景：终末期肾病（ESRD）患者进行肾移植的有效检查和列表，通常有多种合并症，对移植团队构成挑战。肥胖是与ESRD和肾移植（KT）受者的不良结局相关的常见合并症。长期以来，减肥和代谢手术（BMS）已被确立为病态肥胖的安全有效治疗方法。在这项研究中,作者旨在评估ESRD或肾移植患者减重手术疗效和安全性的有力证据.
方法：使用关键术语进行了文献检索，包括“移植”，\"肾\",\"肾\",“肥胖”，和“减肥”。搜索的数据库包括MEDLINE,EMBASE和WebofScience从成立至今（2021年4月）。使用纽卡斯尔-渥太华工具评估方法学质量。然后将选定的文章分类为等待等待名单接受的患者，等待移植的患者，同时接受BMS+KT的患者和先前肾移植后接受BMS的患者.总结效果以统计显著性水平和95%置信区间呈现。
结果：经文献检索，共选取28篇文献。14项关于等待上市的患者的研究(n=1903)，KT等候名单上的患者中有9人(n=196)，一项关于同时BMS和KT的研究和十项关于KT后BMS患者的研究(n=198)。等待上市的患者的BMI平均变化为-11.3kg/m2（95CI：-15.3至-7.3，p<0.001），KT患者BMI的平均变化为-11.2kg/m2(95CI:-12.9~-9.5,p<0.001),KT患者BMI的平均变化为-11.0kg/m2(95CI:-7.09~-14.9,p<0.001).同时经历BMS和KT的患者的综合死亡率为4％（n=15）。
结论：本综述证明BMS在KT之前和KT之后的ESRD患者中既安全又有效。这将使难以列出的肥胖接受者有可能进行移植，应将其视为工作过程的一部分。
方法：使用关键术语进行了文献检索，包括“移植”，\"肾\",\"肾\",“肥胖”，和“减肥”。搜索的数据库包括MEDLINE,EMBASE和WebofScience从成立至今（2021年4月）。使用纽卡斯尔-渥太华工具评估方法学质量。然后将选定的文章分类为等待等待名单接受的患者，等待移植的患者，同时接受BMS+KT的患者和先前肾移植后接受BMS的患者.总结效果以统计显著性水平和95%置信区间呈现。
结果：经文献检索，共选取28篇文献。14项关于等待上市的患者的研究(n=1903)，KT等候名单上的患者中有9人(n=196)，一项关于同时BMS和KT的研究和十项关于KT后BMS患者的研究(n=198)。等待上市的患者的BMI平均变化为-11.3kg/m2（95CI：-15.3至-7.3，p<0.001），KT患者BMI的平均变化为-11.2kg/m2(95CI:-12.9~-9.5,p<0.001),KT患者BMI的平均变化为-11.0kg/m2(95CI:-7.09~-14.9,p<0.001).同时经历BMS和KT的患者的综合死亡率为4％（n=15）。
结论：本综述证明BMS在KT之前和KT之后的ESRD患者中既安全又有效。这将使难以列出的肥胖接受者有可能进行移植，应将其视为工作过程的一部分。
